Provider Demographics
NPI:1669630455
Name:JAMES A BURNESON DDS LLC
Entity Type:Organization
Organization Name:JAMES A BURNESON DDS LLC
Other - Org Name:TODAY'S DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNESON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-482-7771
Mailing Address - Street 1:1530 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2406
Mailing Address - Country:US
Mailing Address - Phone:541-482-7771
Mailing Address - Fax:541-482-9301
Practice Address - Street 1:1530 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520
Practice Address - Country:US
Practice Address - Phone:541-482-7771
Practice Address - Fax:541-482-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD79011223G0001X
ORD90171223G0001X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty